Questionnaire updates in the e-referral system in September and October 2020

We use our authorization criteria and medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your authorization requests.

In September and October:

• We're updating two questionnaires in the e-referral system.
• We're removing one questionnaire from the e-referral system.

As questionnaires are updated or removed, we'll update or remove the corresponding preview questionnaires on this website.

Updated questionnaires

• Endoscopy, upper gastrointestinal, for gastroesophageal reflux disease: On Sept. 27, 2020, we’ll update the list of procedure codes for which providers must complete this questionnaire for BCN HMO^SM and BCN Advantage^SM members.

  Starting Sept. 27, providers must complete this questionnaire for these procedure codes: *43191, *43192, *43193, *43195, *43196, *43197, *43198, *43200, *43201, *43202, *43214, *43231, *43233, *43235, *43237, *43238, *43239, *43241, *43242, *43248, *43249, *43250, *43253, and *43259

  Providers will no longer need to complete the questionnaire for these procedure codes: *43180 and *43254.

• Sacral nerve neuromodulation/stimulation: On Oct. 11, we'll update this questionnaire for Medicare Plus Blue^SM PPO, BCN HMO and BCN Advantage members.

Removed questionnaire

On Sept. 27, we'll remove the Lumbar spine surgery, minimally invasive questionnaire for BCN Advantage members. The e-referral system will automatically approve requests for code G0276.

Preview questionnaires

You can access preview questionnaires on this website. The preview questionnaires show the questions you'll need to answer in the actual questionnaires that open in the e-referral system. This can help you prepare your answers ahead of time.

To find the preview questionnaires:

• For BCN: Click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the “Authorization criteria and preview questionnaires” heading.
• For Medicare Plus Blue: Click Blue Cross and then click Authorization Requirements & Criteria. In the "Medicare Plus Blue PPO members" section, look under the “Authorization criteria and preview questionnaires - Medicare Plus Blue PPO” heading.

Authorization criteria and medical policies

The pertinent authorization criteria and medical policies are also available on the Authorization Requirements & Criteria pages.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.

Posted: September 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network